Medication is a relatively inexpensive and efficient therapeutic strategy for treating a number of illnesses. However, the average rate of compliance for patients on chronic therapies is about 50% after one year and declines over time. Medication noncompliance is estimated to cost the US healthcare system an estimated $76.6 billion a year. Approximately 10% of hospital admissions are related to medication issues, costing up to $50 billion annually.
Understanding the causes of noncompliance and identifying methods to help patients follow their regimens may improve health outcomes and reduce related costs. Health decision models suggest that noncompliant behavior is multifactorial. By modifying general and specific health beliefs, modifying social interaction factors, and enhancing administration, compliance can be improved. The enhanced compliance program proposed herein focuses specifically on modifying social interaction factors and providing a tool to enhance the administration process.
The elderly represent an important population among those receiving drug therapy. They receive 30% of all prescriptions—twice as many as the general population—and they buy 40% of all over-the-counter drugs. In 2000, there were an estimated 35 million people age 65 or older in the United States, accounting for almost 13% of the total population. In 2011, the “baby boom” generation will begin to turn 65, and by 2030, it is projected that 20% of the population will be age 65 or older.
The inability to manage medications is one of the leading reasons why seniors need additional and often more expensive care, such as assisted living facilities or nursing homes: 23% of caregivers report issues associated with medications, 23% of nursing home admissions are related to medication problems and 80% of assisted living residents have medications managed by their facilities. Elderly patients tend to have difficulty complying with or adhering to medication regimens that may tax their cognitive skills. Older adults evidence a decline in a number of cognitive domains and appear to comprehend and remember less about medication information than young adults. In field studies, the oldest segment (those over age 77) were found to be the most nonadherent. Understanding the causes of noncompliance and identifying methods to assist elderly patients in following their regimens may improve health care outcomes.
In general, understanding the reasons for noncompliance provides a basis for reducing the incidence of noncompliance. However, a need still exists for structural methods for helping the elderly conform to prescribed medication regimens.